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Commentary
First Tamiflu
Resistant Fatality in South Korea
Recombinomics
Commentary 18:14
December 17, 2009
The one-year-old girl died on December 1 in hospital, the health ministry said, adding that health officials discovered a strain of the (A)H1N1 virus resistant to Tamiflu in her body.
The above comments describe the first Tamiflu resistant death in South Korea. This follows reports from the United States and Netherlands on an extraordinarily high frequency of deaths in patients with H274Y. In the United States 4 of 10 recent cases were fatal while in the Netherlands 4 of 11 recent cases were fatal.
Earlier reports of H274Y in a least one fit case was associated with the receptor binding domain change, D225E. However, recent linkage of D225G and D225N to fatal cases has raised concerns that H274Y would be found these other changes at position 225, and this associate of H274Y with D225G was found in a patient in the United States as well as France.
Moreover, the recent report of efficiently transmitted H274Y in Vietnam has increased concerns that H274Y is widespread and transmitting as a mixture, with increased ratios of genomes with H274Y leading to explosion of H274Y confirmed cases in the United States and worldwide in the past few weeks.
Recently released sequences from Texas have identified D225E in patients which had additional markers in common with isolates with H274Y. Recently released sequences by the CDC at GISAID have supported significant spread of this sub-clade, which was also in recent isolates from Japan.
The dramatic jump in H274Y, along with linkage to fatal cases and receptor binding domain changes, continues to increase pandemic concerns.
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